Fitzroy Henry Graham, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

048780 Issued in GA

Practice address

105 Mirramont Lake Dr Ste 100
Woodstock, GA 30189-8214

Phone

(770) 485-9670

Fax

(678) 401-7658

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Graham Pediatrics of Woodstock LLC

  • Pediatrics Physician
  • Woodstock, GA
  • NPI 1316485717
  NPD (past) Authorized official
• Jonathan a. Cheek, M.D.

  • Pediatrics Physician
  • Canton, GA
  • NPI 1922261106
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1538120092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MIRRAMONT LAKE DR",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898214",
            "telephone_number": "770-485-9670",
            "fax_number": "678-401-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MIRRAMONT LAKE DR STE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898214",
            "telephone_number": "770-485-9670",
            "fax_number": "678-401-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "FITZROY",
        "middle_name": "HENRY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "048780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000919663B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia E. Gore, PSY.D.
• Dana Gorum
• Sidney A Gottlieb, O.D.
• Christopher Allen Goult, PT, DPT
• Graham Pediatrics of Woodstock LLC
• Rachel Graham, NTP
• Rebecca Crawford Graham, MA, LPC, CACII
• Grainne Transportation LLC
• Samantha Liane Grant, MBBS
• Angela M Graves

• Pediatrics Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.